For 2021, MAOs Face Small Pay Boost, ESRD Uncertainty

With an estimated pay boost just under 1% and the continued increase of encounter data used in determining Medicare Advantage plans’ risk scores, MA reimbursement in 2021 isn’t looking as robust as it has in recent years now that both parts of the 2021 Advance Notice have come out.

Meanwhile, MA plans face new uncertainties as patients diagnosed with end-stage renal disease (ESRD) can begin enrolling in such plans on Jan. 1, 2021. And while some changes in Part II of the Advance Notice stand to lower rates for serving ESRD enrollees, CMS in a separate memo proposed a new methodology for setting maximum out-of-pocket (MOOP) cost limits that will partly account for ESRD costs starting in 2021.

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